Chain of custody record with contact details, Westchester County

NYC 9/11 Public Portal Document ................................................................. -v'-..- • ................................................

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III UlMlchMtar County f. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 s NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Time/Date Set: Sample 'pe (circle one): Q A16, : ;S I ij. Potable 3. Non-Potable Treated Bottle #’s: prOti Ht'L) . 2. Non-Potable 4. Other _____________ Chain of Custody? yes no T ' Time/Date Collected:. Comments: Collected Bv: T). TO > b a ---------------- Agency Code: PWS #: __________ Source ID:. ■ Type Descriptor: Collected From: . Bill to: Location's/lndividual's Name cO O v < 7 Name/Company Street___i_______ ?■ ■______________ Street *' City/St/Zip__________ •_______________ ________ City/St/Zip Identification of ,Source; Phone#:, Fax #: Collection,Point: S 0 I CA, CH. Bl? • Check#: Amounts. .. i C, ■ BACTERIOLOGICAL ANALYSES -' ORGANIC POTABLE ANALYSES > ORGANIC NONPOTABLE/SOLID ANALYSES ■ Lab • (drclotests) ■ - ' . " 'A . - (circle tests) " 1. Heterotrophic Plate > Trihalomethanes (524) ’ ■ ; 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & others) • Volatile HalocarboW(524^,- ■ 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public sujjplies) ; . y^Volatile Aromatics (524)^ 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv weH,'raw, stp) rX Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 1 4. Fecal Coliform (all samples) 5. Microextractables (504) „ 5. Orga'nochlorine Pesticides (608/8080) .T 5. Microscopic > : \ Pesticides (507) \ '6. PCB’s (Arochlors) (608/8080) ’ 6. Macroscojaic '• ■ ' 1 - Pesticides/PCB scrq)^(508) . 7. Herbicide^ (SM-18/6640; 8151) 7..'APi . - ■ \ ; 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other:______ '________ __i ^Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) ! 10. Glycols in Water Refrigerated? yes • -V no V . 11. Carbamate Pesticides (531) ‘ 11. Acid Extractables (625/8270) 12. Glyphosate (547) 1Z Base Neutral Extractables (625/8270) Chionnated?: .yes V-: no yA 13. Diquat (549) T^^C/MS Unknown Scan ■ ■■

14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:, .mg/L ■ 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: .mg/L- • 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF) c f.i’ ■ T-

INORGANIC ANALYSES REQUESTEDf Lab#: 7~ (circle tests) ‘ /3^Aluminum 1. Color n 59. Potassium 2. Turbidity Alkalinity, as CaCOa / 40.Wntimony /6O.')Selenium 3. pH Bromide | 41. kr!senic ( 6l/Silver 4. Conductivity .i23. Bfomate/Chlorate/Chlorite I 42. 3arium ■62. Sodium 5. Corrosivity (temp: .’C) Chloride leryllium (Thallium 6. BOD (5 day) Cyanide 44. Boron •■6<'Vanadium

7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium /gsC^inc________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs "cEp 9. Chemical Oxygon Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca’^ 66. Metals/CN '^lO. Dissolved Oxygeri 29. Nitrogen, Nitrate as N ^^Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N J^Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N /'sO^obalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil and Grease / 51. Copper 70. Disk Deliverables 14. Solids. Settleable 33. Phenol I 52. Iron TCLP 15. Solids. Suspended 34. Phosphorus. Total as P 1 53yLead 71.TCLP-Metals 16. Solids. Total »' 35. Phosphorus, Ortho as P TJ^tfMagnesium ’'72. TCLP-Pesticides 17. Solids. Total Dissolved 36. Sulfates Z/SS.y^anganese 73. TCLP-Herbicides 18. Solids, Total Volatile , 37. Surfactants /; 56. Mercury . 74. TCLP-Volatiles 19? Other: ? 38. I.IV254 { 57. Molybdenum 75. TCLP-BNA’s \ 7 \ 58.Nickel

NYC-WTC_000070986.....................